Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Cancer Med. 2021 Oct;10(20):7079-7088. doi: 10.1002/cam4.4241. Epub 2021 Aug 31.
This study assesses the mortality outcomes of non-vitamin K antagonist oral anticoagulants (NOACs) in cancer patients with venous thromboembolism (VTE) and atrial fibrillation (AF).
Medical records of cancer patients receiving NOACs for VTE or AF between January 1, 2011, and December 31, 2016, were retrieved from Taiwan's National Health Institute Research Database. NOACs were compared using the inverse probability of treatment weighting (IPTW) method. The primary outcome was cancer-related death. Secondary outcomes were all-cause mortality, major bleeding, and gastrointestinal (GI) bleeding.
Among 202,754 patients who received anticoagulants, 3591 patients (dabigatran: 907; rivaroxaban: 2684) with active cancers were studied. Patients who received dabigatran were associated with lower risks of cancer-related death at one year (HR = 0.71, 95% CI = 0.54-0.93) and at the end of follow-ups (HR = 0.79, 95% CI = 0.64-0.98) compared with rivaroxaban. Patients who received dabigatran were also associated with lower risks of all-cause mortality (HR = 0.81, 95% CI = 0.67-0.97), major bleeding (HR = 0.64, 95% CI = 0.47-0.88), and GI bleeding (HR = 0.57, 95% CI = 0.39-0.84) at the end of follow-ups compared with rivaroxaban.
Compared with rivaroxaban, the use of dabigatran may be associated with a lower risk of cancer-related death and all-cause mortality.
本研究评估了非维生素 K 拮抗剂口服抗凝剂（NOACs）在伴有静脉血栓栓塞（VTE）和心房颤动（AF）的癌症患者中的死亡率结局。
从台湾国家健康研究所研究数据库中检索了 2011 年 1 月 1 日至 2016 年 12 月 31 日期间接受 NOACs 治疗 VTE 或 AF 的癌症患者的病历。采用逆概率治疗加权（IPTW）法比较 NOACs。主要结局为癌症相关死亡。次要结局为全因死亡率、大出血和胃肠道（GI）出血。
在接受抗凝治疗的 202754 例患者中，有 3591 例（达比加群：907；利伐沙班：2684）患有活动性癌症。与利伐沙班相比，接受达比加群治疗的患者在一年内（HR=0.71，95%CI=0.54-0.93）和随访结束时（HR=0.79，95%CI=0.64-0.98）癌症相关死亡的风险较低。与利伐沙班相比，接受达比加群治疗的患者在随访结束时全因死亡率（HR=0.81，95%CI=0.67-0.97）、大出血（HR=0.64，95%CI=0.47-0.88）和胃肠道出血（HR=0.57，95%CI=0.39-0.84）的风险也较低。
与利伐沙班相比，达比加群的使用可能与癌症相关死亡和全因死亡率降低相关。
